Screening for Abdominal Aortic Aneurysm

Abstract

IMPORTANCE An abdominal aortic aneurysm (AAA) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger. The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries. The current prevalence of AAA in the United States is unclear because of the low uptake of screening. Most AAAs are asymptomatic until they rupture. Although the risk for rupture varies greatly by aneurysm size, the associated risk for death with rupture is as high as 81%.OBJECTIVE To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3.0-5.4 cm in diameter) identified through screening.POPULATION This recommendation applies to asymptomatic adults 50 years or older. However, the randomized trial evidence focuses almost entirely on men aged 65 to 75 years.EVIDENCE ASSESSMENT Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit. The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit. The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA. The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits.RECOMMENDATIONS The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group. (C recommendation) The USPSTF recommends against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA. (I statement)

Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study

“…An abdominal aortic aneurysm (AAA) is a slowly progressing vascular disease, causing an enlargement of the infrarenal aorta and is considered pathological if the aortic diameter exceeds 30 mm [1]. AAA prevalence has been reported within a range of 1.2% to 3.3% in men older than 60 years based on several studies in western societies [2]. In most cases, AAAs develop asymptomatically over several years, but they can rapidly turn into a serious clinical emergency in case of rupture.…”

Isolated ascending aorta dilatation is associated with increased risk of abdominal aortic aneurysm

“…Upon finding of abnormal ascending aorta indices, we recommend screening of the abdominal aorta by means of 2D-TTE, as show to be feasible with minimal additional time and cost compared to separate abdominal ultrasound examination [16,17]. Our recommendation extends the current guidelines which recommend 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked [6].…”

“…To conclude, routine 2D-TTE examination of the ascending aorta is a rapid, accurate and cost-effective tool to identify a 'silent' highrisk AAA population for which further evaluation may be beneficial [17,20]. These are particularly relevant when screening for AAA may be overlooked, or screening programs with ultrasonography may not be fully implemented [6,21]. Clinical awareness, and performance of comprehensive echocardiographic analysis, can help in early diagnosis to reduce AAA-associated risks, reduce mortality and morbidity as well as the economic burden.…”

“…Smoking, hypertension, elevated cholesterol levels, and obesity are among the most common modifiable risk factors [3][4][5]. The current U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for abdominal aortic aneurysm, recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked (B recommendation) [6]. However, a recent study by Carnevale and collaborators emphasized the need of expanding the established USPSTF screening guidelines to include the expanded Society for Vascular Surgery (SVS) criteria which may potentially double the number of patients identified with AAA [7].…”

A Simple Target Will Save the Day and the Kidney: This Is How We Perform Our Endovascular Fenestrated Graft Procedure

“…It was discovered that smoking was the greatest risk factor for aneurysm formation with a graded increased association relative to the length of time smoking [ 4 ]. Recommendations by the United States Preventative Services Task Force (USPSTF) consist of one-time ultrasound in men ages 65-75 who have ever smoked to screen for AAA [ 5 ]. Most AAAs go unnoticed until they rupture, resulting in a mortality rate of around 60-80% [ 6 - 7 ].…”